Provider Demographics
NPI:1730488537
Name:METROPOLITANO ARECIBO
Entity Type:Organization
Organization Name:METROPOLITANO ARECIBO
Other - Org Name:LABORATORIO CLINICO
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-650-0097
Mailing Address - Street 1:PO BOX 9976
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9976
Mailing Address - Country:US
Mailing Address - Phone:787-650-0097
Mailing Address - Fax:787-650-0099
Practice Address - Street 1:CARR 129 INT
Practice Address - Street 2:ZONA INDUSTRIAL VICTOR ROJAS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-650-0090
Practice Address - Fax:787-650-0099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST HEALTH CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1039291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40D0992949OtherCLIA
PR1039OtherSTATE LICENSE